RADICAL PROSTATECTOMY AND RADICAL RADIATION-THERAPY FOR CLINICAL STAGE-T1 TO STAGE-T2 ADENOCARCINOMA OF THE PROSTATE - NEW INSIGHTS INTO OUTCOME FROM REPEAT BIOPSY AND PROSTATE-SPECIFIC ANTIGEN FOLLOW-UP

Assessment of outcome following radical treatment for stages T1 to T2 prostate cancer has become more sensitive and rapid with the use of se rum prostate specific antigen (PSA) in routine followup. PSA has ident ified substantially more failure following all radical therapies than was previously detected in series using clinical end points. Furthermo re, it has also allowed a better assessment of the biological potentia l of histologically evident residual disease, that is a positive surgi cal margin after prostatectomy or positive repeat biopsy 2 years after radiation. Both situations are associated with subsequent biochemical failure in the majority of patients. The stages T1 to T2 cancer group is extremely heterogeneous. In the few series with PSA followup that have evaluated long-term (greater than a decade) outcome for this grou p some report cure rates well below 40% for surgery and radiation. Whe n comparing the results of any radical treatment series (surgery versu s surgery and radiation versus radiation, as well as radiation versus surgery) selection may have a crucial role in predicting outcome. Surg ical series tend to contain more patients with stages T1 to T2a tumors of low grade who have low initial PSA values and are known to have ne gative nodes. These patients, when treated with radical radiation, als o have a favorable prognosis. It is hoped that the introduction of scr eening programs will improve outcome through earlier disease detection .